Would dose timing help this?

[Karenjaninaz]

I’ve been on pred since 11/2015 - a long time. Was down to 4.5 when hospitalized with asthma. The heavy steroid doses set my taper back.

I haven’t had any PMR pain in years even at low-doses. My main problem is getting off the prednisone without going crazy. I am now tapering from 8 1/2 to 8. I take this at 5:30 on arising. Once I-reached 5 days on the lower dose I feel terrible on awakening. I call this feeling “adrenal”. By noon I feel well and can do normal stuff.

At one point in my PMR career, at various time, I was taking split doses, or a dose during my nighttime loo visit. Sometimes, after this, I couldn’t go back to sleep. Or, if I took enough of my shake to wash it down(2:30-3:30am), then I might wake up for another loo stop.

Should I go back to wee hours again? Maybe I answered my own question.

I don’t want to interfere in any way with adrenal resurrection.

[PMRpro Ambassador]

Only one way to find out isn't there! As long as the night dose is after midnight it shouldn't interfere with adrenal recovery - you want to have as low an amount in the blood as possible at midnight.

[PMRnewbie2017]

At 8mg I would go back to early mornings and have done so, especially if the PMR is still active. At 4mg and below I think it's better to move towards "breakfast " time as natural cortisol levels should peak around 8am to 9am.

[PMRpro Ambassador in reply to PMRnewbie2017]

Which means taking prednisolone at 7-7.30 and prednisone an hour earlier!

However, that morning peak is misleading. The cortisol awakening response (CAR) is an increase between 38% and 75% in cortisol levels peaking 30–45 minutes after awakening in the morning in some people. This rise is superimposed upon the late-night rise in cortisol which occurs before awakening.

images.app.goo.gl/qUnsWSr9r...

It is the rising cortisol level beforehand that prepares the body for the day - amd that is why not taking pred until 8 or 9 o'clock means a very slow start to the morning and why the 2am dosing time is ideal in every way.

[Karenjaninaz in reply to PMRnewbie2017]

I have absolutely no signs that PMR is active even since the last three years or so. It’s mainly now getting off the prednisone. I do feel better this morning after taking my 8 mg at two in the morning.